Abstract

To the Editors: As a practicing emergency physician and recent graduate of an academically oriented internal medicine residency, I am primed to see support for clinical decision rules that help to make sense of diagnostic work-ups. As Dr. Epstein points out in a recent editorial (1), there is a difficulty in implementing such practices, even when they seem to be well substantiated. He gives several possible explanations but fails to explicitly mention an additional important factor. Specifically, public opinion, the tort system, and individual patients all indicate that there is an unwillingness to accept a diagnostic accuracy of less than